RESEARCH - Fatigue in SLE: contributions of disordered sleep, sleepiness, and depression

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Journal of Rheumatology

December 2006

Fatigue in Systemic Lupus Erythematosus: Contributions of Disordered Sleep,

Sleepiness, and Depression

ANDREA IABONI, DOMINIQUE IBANEZ, DAFNA D. GLADMAN, MURRAY B. UROWITZ, and

HARVEY MOLDOFSKY

ABSTRACT.

Objective. To clarify the role of sleep disorders, sleepiness, and

depression in patients with systemic lupus erythematosus (SLE) who complain

of disabling tiredness.

Methods. Patients with SLE (31 women, 4 men) with disabling tiredness were

evaluated with the Epworth Sleepiness Scale (ESS) and overnight

polysomnography, followed by daytime multiple sleep latency tests (MSLT) and

the Beck Depression Inventory (BDI). Their polysomnography was compared with

17 healthy, asymptomatic controls.

Results. Polysomnography of the patients in comparison with healthy controls

showed impaired sleep efficiency (p < 0.02), high arousal frequencies (p <

0.01), increased stage 1 sleep (p < 0.02), decreased stage 3/4 slow-wave

sleep (p < 0.02), and a high percentage (77% of patients) with increased

alpha-EEG non-REM sleep. In 23% of patients periodic limb movement (PLM)

disorder was observed (mean PLM index 31.1 ± 15); 26% of patients had

obstructive sleep apnea (mean apnea/hypopnea index 19.3 ± 10), and one

patient had narcolepsy-cataplexy. Remarkably, 51% of patients were

excessively sleepy on both the ESS and MSLT (mean sleep latency < 10 min).

This excessive daytime sleepiness was not related to sleep restriction.

There was no association between sleepiness and SLE disease features such as

neuropsychiatric SLE, medications, fibromyalgia, or disease activity. As a

whole, the study group reported mild to moderate depression (mean BDI = 15.8

± 9.9). Within the group, the sleepy patients had lower BDI scores than the

non-sleepy patients (p < 0.02), and fewer of the sleepy patients were

depressed (p < 0.04).

Conclusion. Primary sleep disorders, sleepiness, and depression are common

in tired SLE patients. Tiredness in SLE that is the result of excessive

daytime sleepiness can be distinguished from tiredness of depression. Such

distinctions will help identify appropriate treatment for tired patients

with SLE. (First Release Oct 1 2006; J Rheumatol 2006;33:2453-7)

http://www.jrheum.com/abstracts/abstracts06/2453.html

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